Provider Demographics
NPI:1255661609
Name:KING, DEREK BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:BRIAN
Last Name:KING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 S RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2209
Mailing Address - Country:US
Mailing Address - Phone:309-837-6932
Mailing Address - Fax:309-837-3106
Practice Address - Street 1:227 S RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2209
Practice Address - Country:US
Practice Address - Phone:309-837-6932
Practice Address - Fax:309-837-3106
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011583111N00000X
IL038.011583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor